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AMK > Neurology > Flashcards

Neurology Flashcards

1
Q

Crescent shaped haemorrhage - what is it, Px and cause?

A

Subdural haemorrhage
Caused by rupture of bridging veins
Presents with gradually increasing confusion

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2
Q

lemon shaped haemorrhage - what is it, Px and cause?

A

Extradural haemorrhage
Trauma to pterion, rupture of the middle meningeal artery
Px = trauma, lucid period, rapid decline

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3
Q

thunderclap headache after strenuous activity. what is it, cause and special Mx

A

subarachnoid haemorrhage.
aneurysm rupture
endovascular coiling

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4
Q

recognising stroke in ED tool

A

ROSIER

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5
Q

5 points for haemmorhagic stroke Mx

A
  1. non contrast CT head
  2. BP control to <140mmHG (IV labetalol)
  3. reverse anticoagulation
  4. refer to neurosurgery
  5. if aneurysm = endovascular coiling
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6
Q

reversing warfarin

A

vitamin K & prothrombin complex concentrate

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7
Q

reversing dabigatran

A

idaracizumab

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8
Q

factor Xa reversal

A

prothrombin complex concentrate

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9
Q

how to differentiate ischaemic and haemorrhagic stroke on CT

A

ischaemic = hypodense
haem = hyperdense

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10
Q

gold standard diagnosis for ischaemic stroke

A

Diffusion weighted MRI

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11
Q

management of ischaemic stroke

A

thrombolysis (alteplase) within 4.5hrs
if presents after 4.5hrs: mechanical thrombectomy

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12
Q

long term management of ischaemic stroke

A

aspirin and clopidogrel
atorvastatin to prevent recurrence

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13
Q

contraindications to thrombolysis

A

intracranial/GI bleed
major surgery in the last 2 weeks
INR >1.7

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14
Q

horners syndrome

A

ptosis, miosis, anhidrosis

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15
Q

Wallenberg syndrome (lateral medullary)
what vessel is occluded

A

ipsilateral: ataxia, nystagmus, face numbness, horners

contralateral: body numbness

PICA occlusion

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16
Q

Lateral pontine

A

similar to wallenberg

ipsilateral hearing loss

AICA occlusion

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17
Q

Locked in syndrome
which artery is occluded

A

tetraplegia, preserved consciousness and vertical gaze

basilar artery occlusion

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18
Q

pathophysiology of MS

A

inflammatory demyelination of CNS neurones causing destruction go oligodendrocytes

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19
Q

two main types of MS

A

relapse-remitting (occurs in phases with improvement)
Primary progressive (gradual deterioration)

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20
Q

presentation of MS

A

optic neuritis = painful eye movements, red desats, loss of central vision
Internuclear ophthalmoplegia (nystagmus during horizontal vision)
parasthesia
cerebellar ataxia

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21
Q

what does MRI show in MS?

A

paraventricular plaques

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22
Q

methylprednisolone is the management of …

A

acute attacks of MS

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23
Q

two drug classes used for RRMS

A

disease modifying = interferon-beta/fingolimod
symptoms reducing e.g. amantadine for fatigue

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24
Q

cause of guillain barre

A

infective gastroenteritis (campylobacter jejuni, CMV, epstein barr virus)

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25
Q

pathophis of guillain barre

A

demyelination of PNS

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26
Q

symmetrical ascending weakness of the limbs
reduced reflexes
parasthesia

A

Px of guillain barre

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27
Q

medical management for guillain barre

A

IV immunoglobulin
plasmapheresis

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28
Q

differentiating between guillain barre and miller fisher

A

Miller-fisher starts proximally, Guillain barre starts distally

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29
Q

muscle weakness condition linked to thymoma

A

myasthenia gravis

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30
Q

presentation of myasthenia gravis

A

eye drooping, double vision
weak facial muscles, jaw
trouble swallowing, slurred speech

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31
Q

what is pyridostigmine?

A

acetylcholinesterase inhibitor
Mx for myasthenia gravis

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32
Q

similar symptoms to myasthenia gravis but has small cell lung cancer

A

Lambert eaton syndrome

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33
Q

Mx of lambert eaton syndrome

A

amifampridine
allows more ACh into synapse

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34
Q

Px of ramsay hunt syndrome

A

unilateral facial nerve palsy
hearing loss
herpetic rash in ear canal

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35
Q

Mx of ramsay hunt syndrome

A

Aciclovir
Prednisolone

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36
Q

Mx of tonic clonic seizure

A

lamotrigine (if female of reproductive age)
sodium valproate

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37
Q

Mx of absence seizures

A

ethosuximide

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38
Q

Mx of focal seizures

A

lamotrigine

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39
Q

Mx flowchart for status epilepticus

A
  1. rectal diazepam / IV lorazepam if you have IV access
  2. sodium valoproate
  3. general anaesthesia
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40
Q

triad of huntingtons disease

A

autosomal dominant inheritance
choreoathetosis
dementia

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41
Q

MRI in huntingtons

A

atrophy of caudate nucleus and putamen

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42
Q

MRI in alzheimers

A

widespread cerebral atrophy

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43
Q

Px of charcot-marie-tooth syndrome

A

high foot arch
distal muscle wasting (reverse champagne bottle legs)
reduced muscle tone
peripheral neuropathy

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44
Q

features of Brown-Sequard syndrome

A

damage to a hemisection of the spinal cord
Results in:
ipsilateral: loss of proprioception, paralysis, hyperreflexia
contralateral: loss of pain and temperature sensation

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45
Q

loss of pain/temp sensation and motor function below the lesion
what is this???

A

anterior cord syndrome

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46
Q

loss of proprioception below the lesion
what is this?

A

posterior cord syndrome

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47
Q

bladder/bowel dysfunction
lower back+leg pain
lower limb motor deficit
loss of perianal sensation and tone

what is this and what is the main cause?

A

Cauda equina syndrome
Massive herniated disc

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48
Q

multiple system atrophy

A

parkinsonism + autonomic dysfunction e.g. postural hypotension; incontinence; impotence

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49
Q

corticobasal degeneration

A

Parkinsonism + spontaneous limb movements / akinesia

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50
Q

progressive supranuclear palsy

A

Parkinsonism + impaired vertical gaze

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51
Q

lewy body dementia

A

Parkinsonism + hallucinations

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52
Q

what is a positive Romberg’s sign and what does it show?

A

eyes closed, can’t stand still
shows that there is sensory ataxia due to a dysfunctional dorsal column - can’t detect proprioception

53
Q

Cushings Triad

A

signs of raised ICP
1. bradycardia
2. hypertension
3. irregular breathing

54
Q

wernicke’s encephalopathy triad, why does this happen

A
  1. confusion
  2. ataxia
  3. ophthalmoplegia

this happens due to thiamine deficiency in alcohol overuse

55
Q

cluster headache: px and mx

A

unilateral eye pain, bloodshot eye, vomiting, rhinorrhoea
Mx = sumatriptan

56
Q

cluster headache: px and mx

A

unilateral eye pain, bloodshot eye, vomiting, rhinorrhoea
Mx = sumatriptan
Proph = verapamil

57
Q

tension headache

A

band around the head, non-pulsatile
Mx = pain relief

58
Q

migraine
Mx

A

Px: photophobia, nausea, aura
Mx = sumatriptan
Proph = propanolol

59
Q

headache associated with obese women, stooping and in the mornings

A

idiopathic intracranial headache

60
Q

sharp stabbing pain on the side of head when eating/talking

A

Trigeminal Neuralgia

Mx = carbamazepine
vascular decompression

61
Q

giant cell arteritis triad

A
  1. headache
  2. jaw claudication
  3. temporary loss of vision
62
Q

management of giant cell arteritis

A

prednisolone

63
Q

meningitis px

A

fever, neck stiffness, headache, photophobia, non-blanching rash

64
Q

bacterial meningitis CSF

A

low glucose, high protein, high WBC

65
Q

viral meningitis/encephalitis CSF

A

normal glucose, high protein

66
Q

Mx of meningitis

A

in GP = IM benzylpenicillin
in hospital = IV ceftriaxone/aciclovir

67
Q

Px of encephalitis (diff. it from meningitis)

A

fever, headache, bizarre behaviour, confusion, seizures

68
Q

Mx of encephalitis

A

IV acyclovir and ceftriaxone

69
Q

alcohol withdrawal stages

A
  1. tremor, anxiety, palpitations
  2. hallucinations
  3. delirium tremens: ataxia, seizures, confusion
70
Q

Mx of alcohol withdrawal

A

chlordiazepoxide + pabrinex (contains thiamine, prevents wernickes encephalopathy)

71
Q

Px of opioid toxicity

A

drowsiness, respiratory distress, constricted pupils

72
Q

Mx of opioid toxicity

A

naloxone

73
Q

tongue fasciculations, dribbling, trouble swallowing

A

bulbar palsy due to lower motor neurone lesion in CN 9, 10, 12

74
Q

UMN lesion vs LMN lesion
site, muscle tone, fasciculations, reflexes

A

UMN : cerebrum, brainstem etc. LMN: anterior horn cell, nerve roots
UMN: spasticity, LMN: hypotonia
LMN: fasciculations present
UMN: hyperreflexia

75
Q

acute onset confusion, fluctuation, inattention

A

delirium

76
Q

seizure like movements, pelvic thrusting, back arching

A

pseudoseizure

77
Q

focal seizure - temporal lobe

A

lip smacking, deja vu, hallucinations, olfactory sensations

78
Q

focal seizure - frontal lobe

A

motor: paralysis, eye movements to the side
twitching
Stiffening

79
Q

focal seizure - parietal lobe

A

tingling
Vertigo
Parasthesia

80
Q

focal seizure - occipital lobe

A

spots and lines in the visual field
Scotoma
Amaurosis

81
Q

managing acute raised ICP

A

hyperventilation, elevate the head of bed, mannitol, induce hypothermia

82
Q

normal pressure hydrocephalus Px and Mx

A

urinary incontinence, abnormal gait, dementia
Mx: ventriclo-peritoneal shunt

83
Q

suspected TIA Mx

A

aspirin 300mg loading dose, TIA clinic

84
Q

confirmed TIA Mx

A

clopidogrel
atorvastatin

85
Q

difference between stroke and bells palsy

A

bells palsy is a lower motor neurone lesion - forehead is affected

stroke - forehead sparing

86
Q

where is lumbar puncture done

A

L3/4 towards the subarachnoid space

87
Q

crushing to the axillary region causes damage to what nerve? effect?

A

radial nerve
loss of sensation to dorsal thumb and index finger

88
Q

where is the lesion in brown sequard syndrome

A

right side t10

89
Q

dementia classification according to MMSE

A

<10 severe
10-20 moderate
21-26 mild

90
Q

suspected SAH but CT head is clear
next MX

A

lumbar puncture
check for xanthochromia

91
Q

thiamin is vitamin ….

A

b1

92
Q

lesion in parietal lobe causes what visual defect

A

homonymous inferior quadrantinopia

93
Q

lesion in temporal lobe causes what visual defect

A

homonymous superior quadrantinopia

94
Q

triad of parkinsons

A

rigidity
resting tremor
bradykinesia

95
Q

pathophysiology of vasovagal syncope

A

a trigger causes increased cardiac contractility.
vagal firing causes reduced cardiac contractility + reduced vascular tone.
reduced preload and venous return
mean arterial blood pressure drops to below the level of cerebral auto regulation
reduced cerebral perfusion
transient loss of consciousness

96
Q

CN VIII UMN vs LMN palsy Px

A

UMN: forehead sparing, facial drooping, slurred speech
LMN = bells palsy. forehead is affected, drooping eyelids and face

97
Q

upper motor neurone features

A

weakness
spasticity
hyperreflexia

98
Q

lower motor neurone features

A

fasciculations
atrophy
hypotonia

99
Q

rapid cognitive decline and myoclonic jerks
suspect what, Ix

A

suspect sporadic creutzfeld jakob disease
Ix electroencephalogram

100
Q

Korsakoffs syndrome
cause
Px

A

B1 (thiamine) deficiency due to chronic alcoholism
anterograde amnesia
confusion
confabulations

101
Q

what is beriberi
epidemiology
cause
risk factors
two types

A

severe form of thiamine (B1) deficiency
rare in West, found in sub saharan africa
Rx: chronic alcoholism, diet consisting of white rice, chronic diarrhoea, long term diuretic use
Wet: cardiovascular system (fast heart rate, swelling)
dry: nervous system (numbness, muscle wasting, confusion)

102
Q

what Ix is done in MND

A

electromyography confirms denervation

103
Q

4 features of MND

A

degenerative disease
affects both UMN and LMN
no eye involvement
no sensory or sphincter disturbance

104
Q

most common type of MND and PX

A

amyotrophic lateral sclerosis
UMN and LMN signs
hyperreflexia, spasticity
fasciculations, atrophy

105
Q

Bulbar palsy cause and Px

A

disease of CN 9-12
quiet nasal speech, weak jaw, flaccid tongue

106
Q

pseudo bulbar palsy cause and Px

A

bilateral lesions above mid pons
spastic tongue, brisk jaw reflect

107
Q

progressive muscular atrophy presents with mainly …. signs

A

LMN

108
Q

primary lateral sclerosis presents with mainly …. signs

A

UMN

109
Q

what drug improves life expectancy in MND

A

riluzole

110
Q

what is used to manage muscle spasms in MND

A

baclofen

111
Q

what nerve is responsible for sensory component of the gag reflex

A

glossopharyngeal

112
Q

what nerve is responsible for the motor component of the gag reflex

A

vagus

113
Q

what proteins are present in alzheimers x 2

A

tau
amyloid precursor protein

114
Q

what proteins are present in frontotemporal dementia x 3

A

TARDP-43
Tau protein
Pick bodies (ballooned neuronal cells)

115
Q

what protein is present in lewy body dementia + parkinsons

A

alpha synuclein

116
Q

what is a coma

A

tate of impaired consciousness in which the patient is not rousable despite external stimuli

117
Q

what is a persistent vegetative state

A

state in which individuals have lost cognitive neurological function and awareness of the environment

but retain non-cognitive function and a preserved sleep– wake cycle.

118
Q

oculocephalic reflex

A

on rotating head to left/right, the eyes will m maintain their position by conjugating movement in the opposite direction

“dolls eye reflex”

119
Q

oculovestibular reflex

A

injecting cold water into the ear causes the eyes to look towards the irrigated side

120
Q

decerebrate posturing
what does it show

A

elbows extended
wrists and fingers flexed
knee extended
plantar flexion

shows upper brainstem lesion

121
Q

decorticate posturing

A

arms flexed at elbow and wrist
knee and ankle extendeed

shows diencephalon lesion (thalamus, hypothalamus, cerebellum)

122
Q

duchenne’s muscular dystrophy
cause
pathophis
PX

A

x linked recessive
absence of dystrophin
proximal muscle weakness that spreads
cardiomyopathy
“Gower’s” sign to. get up

123
Q

Becker’s muscular dystrophy
cause
pathophis
PX

A

x linked recessive
altered dystrophin
muscle cramps,
cardiomyopathy symptoms are worse

124
Q

occlusion of what vessel causes global aphasia

A

left middle cerebral artery

125
Q

wernickes encephalopathy

A

ophthalmoplegia, ataxia, and confusion

126
Q

entacapone moa and indication

A

COMT inhibitor
prevents elinimation of L-dopa
parkinsons

127
Q

selegiline moa and indication

A

MAOI
reduces metabolism of dopamine in the brain
parkinsons

128
Q

1st line management of parkinsons

A

L dopa + carbidopa

129
Q

numbness
hypo and hyperreflexia
weakness of limbs
ataxia

what is it and what is it assoc. with

A

subacute combined degeneration of the cord

assoc with b12 defieincy / pernicious anaemia

AMK (29 decks)

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